Teaching About AIDS

"We always have to ask what we can displace to make room for this,"
said Bernadette Seick, an assistant superintendent of the Denver
schools. Teacher attrition can also be a barrier to a consistent
approach, she added.

Several Denver teachers who were trained in the Skills for
Life curriculum have transferred or retired, and district leaders
have found it hard to find replacements. "Not every teacher wants to
get into the classroom and show kids how to use a condom," Ms. Seick
said.

A lack of parental involvement can also stand in the way of
successful AIDS-prevention programs, researchers say. While a number of
national surveys show substantial parental support for teaching about
AIDS in schools, many parents balk at the level of detail considered so
vital to making such teaching effective, researchers and advocates
say.

Reaching Gay Students

Because of these barriers, some experts argue that community
efforts, not school programs, should be the central focus of AIDS
education campaigns.

"The most effective AIDS education is peer-to-peer talk, in clubs
and social settings, not necessarily in schools," said Chris Yu, the
program coordinator for Funders Concerned about AIDS, a New York
City-based association of grantmakers that encourages public-private
partnerships to respond to the AIDS crisis.

Research indicates, however, that both school and community
approaches can be effective.

The CDC recently launched a "social marketing" effort that will
target AIDS education money to particular populations of high-risk
youths, such as homosexuals and intravenous drug users, in several
communities. Community-based approaches have been successful in
educating young people who are at high risk for contracting HIV.

A study published in The Journal of the American Medical
Association in 1991 found that small-group counseling sessions with
67 young runaways ages 11-18 were effective in promoting abstinence and
reducing the instances of unprotected sex. After undergoing three
months of counseling, the percentage of youths living in runaway
shelters who reported using condoms consistently nearly doubled, from
33 percent to 63 percent, according to Mary Jane Rotheram-Borus, a
professor at Columbia University and the lead author of the study.

Researchers at the University of California, San Francisco, found in
a 1996 study that educating young gay men about AIDS at social events
like picnics and volleyball games influenced them to practice safer
sex.

While these community-based AIDS education approaches have been
successful in reaching gay youths, who are disproportionately at risk
for the disease, there has been little research on which
classroom-based programs specifically work to protect gay teenagers
from HIV infection.

Such investigations have been stymied by a lack of AIDS curricula
tailored to gay students and by students' unwillingness or inability to
identify themselves as gay, experts say. Some may not even know their
sexual orientation at that age, researchers say.

AIDS education experts point to several other areas that warrant
rigorous study. Research is already under way on which AIDS-prevention
curricula work in middle schools, which are increasingly adopting such
programs.

Another unanswered question is the degree to which a particular
curriculum's successful implementation determines its
effectiveness.

Other researchers cite a need for greater understanding of why young
people engage in risky behaviors to begin with. Understanding a teenage
girl's motivation to have a child, for example, could help educators
devise better curricula, they say.

Slow Progress

Many AIDS education advocates and researchers say that despite the
obstacles before them, school-based initiatives shouldn't be
abandoned.

"For people who say this is an experiment that has failed, we say it
has never been tried," said Carolyn Patierno, the director of program
services for the Sexuality and Education Information Council of the
United States.

SEICUS commissioned the national poll in 1995 that found that only 5
percent of high school students said they had had sex education that
was "comprehensive in nature."

Dr. Santelli of the CDC suggests that AIDS educators view their
efforts in light of the sluggish progress of several other national
health campaigns during this century.

It took years for people to start wearing seat belts in cars, he
said. And while the U.S. surgeon general issued a report in 1964 that
linked smoking cigarettes with cancer, he said, only in recent years
has there been widespread evidence of a cultural shift away from
smoking--bans on airplane flights, in restaurants, and workplaces--and
a drop in the percentage of adults who smoke.

"It's been a large effort by a lot of people over many years," Dr.
Santelli said of anti-smoking efforts. "What really changes behavior is
hearing things over and over again, like your wife nagging you to stop
smoking cigarettes actually works.''

Tim Dunn, the director of school health at the Education Development
Center in Newton, Mass., which tracks curriculum developments, said he
already sees evidence of a shift in schools' approach to AIDS
education.

"Most programs are moving toward these proven effective methods,"
said Mr. Dunn, noting that more school systems are providing AIDS
education in middle schools. "Five years ago that wasn't the case."

But ultimately, some researchers say, AIDS and sex education in
schools must be completely retooled in an effort to provide students
with reasons to stay abstinent and delay parenthood.

Eighty-five percent of young women ages 15-19 who have children out
of wedlock are poor or low-income, said Kristin Moore, the director of
the Washington-based Child Trends Inc. and an expert on teenage
pregnancy.

Only programs that address poverty, attempt to prevent school
failure, and provide job training will have a sustainable impact, she
argued. "Kids think it doesn't matter if they have sex or have a child
because they are going to be working at a fast-food restaurant
anyway."